Large Bowel is not uncommonly involved by extra pelvic endometriosis, however cecal localization is the lowest reported in literature; the differential diagnosis of intestinal endometriosis remains difficult, especially in those patients who underwent surgery in emergency setting. The Authors report a case of cecal endometriosis, operated on the basis of clinical signs of surgical abdomen. At laparotomy macroscopic appearance of the cecal lesion, suggesting a neoplastic mass, induced the equip to perform a right emicolectomy. The Authors discuss the clinical features and the role of surgery in management of extra pelvic endometriosis in emergency setting, in the light of the newest advances in medical treatment.